EFFICACY AND SAFETY OF TELITACICEPT IN TREATMENT OF MINIMAL CHANGE DISEASE AND GENERALIZED MYASTHENIA GRAVIS

 

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https://storage.unitedwebnetwork.com/files/1099/2131abf4816e168c1a0321b5a3d19766.pdf
EFFICACY AND SAFETY OF TELITACICEPT IN TREATMENT OF MINIMAL CHANGE DISEASE AND GENERALIZED MYASTHENIA GRAVIS

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Liangxiang
Xiao
Mengjiao Lin linmengjiao56401@163.com Zhongshan Hospital of Xiamen University Nephrology Xiamen China -
Yanni Zhou zhouyannni2046@sina.com Xiamen Hospital of Trational Chinese Medicine Nephrology Xiamen China -
Liangxiang Xiao liangxiangxiao@xmu.edu.cn Zhongshan Hospital of Xiamen University Nephrology Xiamen China *
 
 
 
 
 
 
 
 
 
 
 
 

Minimal Change Disease (MCD) is a major cause of nephrotic syndrome characterized by podocyte injury mediated through immune dysregulation. Myasthenia Gravis (MG) is a rare antibody-mediated autoimmune disease that disrupts neuromuscular transmission, frequently associated with thymic abnormalities. Both conditions represent distinct but overlapping immune pathologies. To describe the clinical course of a patient with refractory MCD complicated by generalized MG, treated successfully with telitacicept. Telitacicepta recombinant fusion protein that combines the extracellular domain of the transmembrane activator and CAML interactor (TACI) with the Fc portion of human IgG. It simultaneously blocks two key B-cell activating factors: BAFF (B-cell activating factor) and APRIL (A proliferation-inducing ligand).

A 68-year-old male with stage III generalized and treated with methylprednisolone and azathioprine 50 mg bid for 4 years. MG symptoms had largely stabilized by the time of admission to our department.3 months ago, the paitients presented nephrotic syndrome and received renal biopsy, renal pathology shown MCD and acute tubular necrosis, was treated with methylprednisolone (40 mg/day).  However, the patient remained severely proteinuric with recurrent edema after methylprednisolone for 1 month. Importantly, the lack of response to corticosteroids may be partly attributable to steroid resistance, likely secondary to long-term corticosteroid exposure for MG management. So the paitient recived weekly subcutaneous injections of telitacicept 160 mg once weekly and stop using azathioprine after telitacicept initiation. 

After telitacicept initiation, the patient experienced marked reduction in edema. Proteinuria decreased from 15.3 g/day to 0.104 g/day within 2 month, while serum albumin levels increased. Neurological function improved with reduction in quantitative MG (QMG) score, without myasthenic crisis. No severe infections or adverse events were observed.

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This case highlights the therapeutic potential of telitacicept in overlapping autoimmune conditions. By targeting BAFF and APRIL pathways, telitacicept may provide dual benefits in controlling renal autoimmunity and antibody-mediated neuromuscular dysfunction.

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